Manipulation of Wire Past Pylorus

Once the wire is in the stomach a 5Fr Kumpe catheter is placed over the wire and the catheter and the wire are manipulated past the pylorus and to the ligament of trietz. If the pylorus is difficult to locate air or contrast can be injected through the catheter to delineate the anatomy. This contrast/air injection can be done throughout the procedure to confirm anatomy and guide in the direction of the course of the bowel. Once the ligament of treitz is reached the wire is exchanged through the catheter for a stiff wire hydrophilic wire. The appropriate GJ tube is selected and placed over the wire into the jejunum. Both the wire and lumen of the tube should be very wet to ensure that friction does not cause problems in tube placement. Balloon should be inflated with diluted contrast (half and half) and pulled back to the anterior abdominal wall and grommet synched down appropriately. Contrast should be injected into the jejunal port and gastric port to confirm the tube is in the appropriate position

DOI: https://doi.org/10.17797/wgqh4fbxe3